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Factors associated with anterior cruciate ligament (ACL) reconstruction among ACL injuries in Alberta, Canada

2021 Congress Paper Abstracts

Factors associated with anterior cruciate ligament (ACL) reconstruction among ACL injuries in Alberta, Canada

Yuba Raj Paudel, MPH, CANADA Mark F. Sommerfeldt, MD, CANADA Donald C. Voaklander, PhD, CANADA

University of Alberta, Edmonton, Alberta, CANADA

2021 Congress   ePoster Presentation     Not yet rated


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Summary: Although access to ACL reconstruction service has been improved over time, socio-economic barriers persist in utilization of ACL reconstruction in Alberta, Canada.


Anterior Cruciate Ligament (ACL) injury is a common ligament injury, especially among young athletes and often requires surgical reconstruction. However, less is known about utilization of ACL reconstruction in Alberta, Canada.


We used a retrospective cohort design by linking administrative data from Alberta Health covering a period of 2010/11-2018/19. We used 2011 National household survey data to define neighborhood income quintile as a measure of socio-economic status (SES). We identified first emergency department (ED) visits due to ACL injury and followed up those with a diagnosis of ACL injury for a follow up period of 3 years to identify ACL reconstruction. The first primary ACL reconstruction on an individual was defined as an outcome measure. We used multivariable logistic regression to identify factors associated with ACL reconstruction (versus no reconstruction) adjusting for socio-demographic variables and season of injury diagnosis. Those with ACL injury after 1 April 2016, those with date of reconstruction earlier than date of ACL injury and those with more than 1 ACL reconstruction were excluded.


A total of 12,965 participants with a diagnosis of ACL injury in ED between 2010/11 and 2015/16 were included in this analysis. Mean age of the participants was 32.7 years (SD:13.2 years). Males represented 58% of the cohort and nearly 15% were from rural areas.
Of the total ACL injuries, n=8193 (63.2%; 95% CI: 62.4%-64.0%) had an ACL reconstruction within three years from the date of the first ACL injury diagnosis. Multivariable logistic regression analysis revealed that age, sex, income quintile and season of injury diagnosis were independently associated with odds of undergoing ACL reconstruction within 3 years from diagnosis. Compared to those aged 40-49 years, those in 10-19 years (Odds Ratio 1.86,95% CI:1.6-2.0), 20-29 years (OR: 2.0, 95% CI:1.8-2.3) and 30-39 years (OR: 1.7, 95% CI:1.5-1.9) had a greater chances of ACL reconstruction. Whereas those aged 50-59 years (OR:0.4,95% CI:0.35-0.7), and 60 years and above (OR:0.08,95% CI:0.05-0.11) had a lower chance of ACL reconstruction. Females were more likely to have ACL reconstruction compared to males (OR:1.2,95% CI:1.1-1.3). Similarly, people living in the lower SES neighborhood were less likely to have ACL reconstruction compared to those living in the highest SES neighborhood. No difference was detected by urban/rural place of residence on utilization of ACL reconstruction. Having an ACL injury diagnosed in Spring (OR:1.1,95% CI:1.0-1.3) and Fall (OR:1.2,95% CI:1.1-1.4) was associated with higher chances of ACL reconstruction compared to those with ACL injury diagnosed in Summer.


Although access to and utilization of ACL reconstruction has improved over time, socioeconomic barriers persist in the utilization of ACL reconstruction. More research is needed to understand why population characteristics and season of injury diagnosis are associated with odds of ACL reconstruction.

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